PedSPAM August 2001

Welcome to the PedSPAM archive for August. Here are the month's daily SPAMlets from my update reading that you might have missed:

In the News

Wednesday, August 1: Pertussis (whooping cough) is a common cause of prolonged cough in adults and adolescents over 12 (when immunity to whooping cough from childhood immunizations wanes). In this study, a significant finding that helped distinguish a higher risk for pertussis infection was vomiting with cough. "Cough illness of well over 1 month in duration, especially in the presence of violent cough and cough with vomiting, are important signs that may distinguish adolescents and adults with pertussis from those with other cough illnesses," according to the researchers. "Early identification of infected people in these age groups also would permit the consideration of chemoprophylaxis for patient contacts who may be susceptible and at high risk." Clinical Infectious Disease 2001;32:1691-1696.
Thursday, August 2: A nationwide alert has been issued by Mead Johnson Nutritionals (Enfamil®, ProSoBee®, LactoFree®) about potential allergic reactions to the milk protein in some LactoFree infant formula sample packs. Lactofree sample packs do not have the ingredient listing on the box, which could lead parents to think the formula is not cow-milk based. The sample packs in question were distributed in 30 different stores in Colorado, Iowa, Kansas, Louisiana, Minnesota, Missouri, Oklahoma, Tennessee and Texas. No other sizes or forms of the LactoFree formula are affected; specifically, samples for distribution from doctor's offices are all OK. To repeat, this is a labelling issue; there is nothing wrong with the formula itself. A problem could only arise if For more information, do what I did - call the LactoFree Recall Hotline at 1-888-222-9223.
Friday, August 3: Lab Tests Online is a new, noncommercial site that gives patients news and information on a wide array of lab tests. The site has information to help patients understand what their lab test results mean. The site is sponsored by a number of commercial testing laboratories as well as several major pathology professional societies. Reuters Health.
Monday, August 6: Diets high in polyunsaturated fats may on one hand be heart-healthy, but they seem to double the risk of developing childhood asthma, finds an Australian study. The researchers hypothesize that increased consumption of these polyunsaturated fats produces increased levels of a certain inflammation-promoting hormone, prostaglandin E-2. The same study showed a protective effect of breast feeding on asthma, reducing the risk for a child of developing asthma by more than half. Thorax 2001;56:589-595.
Tuesday, August 7: Even small amounts of alcohol consumption - as little as one drink a week - has demonstrable bad effects on childhood behavior, especially in areas of aggression and depression, as measured at age 6-7 years old. Researchers tracked a large number of mother-child pairs over a number of years, and found that problem behaviors exhibited a dose-response effect to maternal alcohol consumption from one drink a week on up. The best advice for pregnant women seems to be: avoid even small amounts of alcohol consumption. Pediatrics Vol. 108 No. 2 August 2001, p. e34
Wednesday, August 8: Government epidemiologists have found that compared to other professionals, school teachers are at increased risk of death from autoimmune diseases such as multiple sclerosis, rheumatoid arthritis, Sjogren's syndrome and systemic lupus erythematosus. This finding is thought to stem from the increased exposure teachers face early in their careers to the Ebstein Barr virus (causative virus of mononucleosis). Journal of Rheumatology 2001;28:1537-1545.
Thursday, August 9: Antibiotics offer only limited benefit for ear infections, finds this study. The authors found in a review of literature published between 1966 and 1999 that most uncomplicated cases of acute otitis media in children resolve spontaneously without complications. Overall, signs and symptoms of ear infection were gone after 4 to 7 days in three-fourths of children not initially treated with antibiotics. Pediatrics 2001;108:239-247.
Monday, August 13: Autism affects about 5 out of 10,000 children by age three. Scientists in the UK say that they are zeroing in on specific areas of chromosomes that might make children susceptible to developing autism. By comparing chromosome structures in autistic and non-autistic siblings, they and others in an international collaborative study consortium have found specific areas on several chromosomes that apparently harbor genes for the tendency to develop autism. Now the researchers will focus on identifying the exact genes responsible. Reuters Health
Tuesday, August 14: A two-dose schedule hepatitis B virus (HBV) vaccination regimen for adolescents is cost effective compared with the currently used three-dose regimen. In public health clinics, the two-dose regimen is cost saving, and teens are more likely to complete the series. Pediatrics 2001;108:317-325.
Wednesday, August 15: The state of Connecticut has made it a crime for a teacher to recommend methylphenidate (Ritalin®) to the parents of a student. Under a law passed recently, a teacher may encourage parents to consult with a doctor, but she may not suggest that a medication be used. Reuters Health
In my view, this is addled political meddling in medicine of the worst sort. I cannot imagine this law withstanding constitutional challenge.

Thursday, August 16: Parents are given holding chamber devices to allow the use of metered dose inhalers for their asthmatic children. A study of these devices in actual use with children finds that poor sealing between the mask and child's face leads to dramatic reductions in the dose of medicine delivered, decreasing the effectiveness of the treatments. The investigators counsel physicians to check this possible trouble area when asthma treatment regimens seem not to be working as well as they should. Pediatrics 2001;108:389-394.
Friday, August 17: Measles - a disease essentially unknown in this country because of required immunizations - can cause an acute brain disorder without the classic measles rash, finds a study in India. Outbreaks of brain inflammation (encephalopathy) with seizures and coma apparently happen often in India. The researchers were able to trace this outbreak to the measles virus, and hope they can learn more to reduce these very serious outbreaks. About half of the cases in this series were fatal in the first 48 hours. Indian Pediatrics 2001;38:589-595.
Monday, August 20 Diabetics have a much higher lifetime risk of atheroschlerotic heart disease (hardening of the arteries). It seems now that risk may begin by the teenage years. A study of diabetic adolescents ages 12 to 21 found that significant amounts of atheroschlerotic plaque was already present in their arteries regardless of body weight, family history, smoking and length of time with diabetes. The atheroschlerosis seems to be related to elevated LDL cholesterol levels. Reuters Health
Tuesday, August 21: There has been concern raised recently about declining fertility rates for men in the United States, and one possible explanation was the introduction years ago of soy-based infant formulas. Soy contains substances known as phytoestrogens, that when eaten mimic the effects of female hormones in the body. This study, the largest controlled study yet undertaken, finds that there are no long term health or reproductive effects identifiable in adults who were fed soy formula as infants. Journal of the American Medical Association 2001;286:807-814.
This study does not totally exonerate phytoestrogens in soy. I would still advise parents not to routinely use soy formula unless there is a medical reason to do so. See also PedSPAM November 1999 for the mention of possible effects on the ultimate fertility of male infants fed soy, and PedSPAM April 2000 for the article on soy effects on the brain in old people.

Wednesday, August 22: Pet hamsters, mice and other rodents pose a risk to pregnant mothers of birth defects in their unborn children, according to research published in the journal Clinical Infectious Disease. These rodents can carry the lymphocytic choriomeningitis virus (LCMV), which can be spread to humans who handle the animals or breathe airborne dust from the rodent droppings. The disease in adults usually has flu-like symptoms and recovery is complete. In the unborn fetus, permanent nervous system damage including cerebral palsy, mental retardation, seizures and, most commonly, blindness or impaired vision can result. Clinical Infectious Disease 2001;33:370-374.
Thursday, August 23: Alternative medicine is becoming increasingly popular in the US, Harvard Medical School researchers report. A large telephone interview survey found that 68% of adults had tried at least one alternative therapy.

The therapies tend to go in and out of fashion. In the 70's, biofeedback, energy healing and imagery were popular. In the 90's, aromatherapy, herbal medicine, massage and yoga were popular.

Consumer demand for "complementary and alternative" therapies has led to coverage by some insurance companies. Most US medical schools now offer courses on these therapies (know thy enemy). The National Institutes of Health has also established an office of complementary and alternative medicine to conduct clinical trials on these therapies. Perhaps NASA will soon open an Office of Caseous Lunar Studies. Annals of Internal Medicine 2001;135:262-268.

The world wants to be deceived." - Sebastian Brant, 1525

Friday, August 24: Omalizumab (Xolair®) is an investigational anti-IgE monoclonal antibody. It neutralizes IgE, the antibody in human bodies that mediates allergic disease. It is given by subcutaneous injection. It shows promise in reducing the number of asthma flareups and need for inhaled steroids in asthmatic children. In a controlled study reported in the journal Pediatrics this month, children with moderate to severe asthma who were given the drug reduced their requirements for inhaled steroids, missed less school, and had fewer acute care doctor visits for asthma. The researchers will now see how the drug affects other allergic diseases such as hay fever (allergic rhinitis) and food allergies. Pediatrics 2001;108.
Monday, August 27: It has been a widely accepted view that teenaged children of bipolar parents have a much greater risk of psychiatric disease than peers from households with healthy parents. A Dutch study now finds that children of parents with bipolar disorder may not have increased risk of developing the disorder by early adulthood after all. Journal of the American Academy of Child and Adolescent Psychiatry 2001;40:1094-1102.
Tuesday, August 28: Children with first time febrile seizures are found in this study to be no more likely of developing a serious bacterial illness than any other children with equivalent levels of fever. In a large study of children with first time simple febrile seizures, rates of serious bacterial illness such as meningitis, sepsis, pneumonia and urinary tract infection were found to be similar to those in febrile children who had no seizure. Academic Emergency Medicine 2001;8:781-787.
We have come a long way from the days of my residency when all febrile seizure patients got a spinal tap, admission to the hospital and 72 hours of intravenous antibiotics.

Wednesday, August 29: Two drops of 24% sucrose solution - sugar water - on a crying infant's tongue can stop his crying immediately. The effect lasts at least 2-3 minutes, and the crying may not restart.
I cannot wait to try this out on some little fussbudgets!

This finding came incidentally in the course of a study of infant crying and colic done by a Canadian researcher. He had mothers keep detailed records of their babies' crying, and found that babies who meet standard criteria for colic - crying three hours or more a day on more than three days a week - seem to be on the upper of the spectrum of infant crying, rather than being different in some other way. Prolonged bouts of crying in all babies whether or not they were judged to be colicky seemed to occur only in the first 6 weeks of life and was gone by the four month checkup. Reuters Health

Friday, August 31: A panel of FDA experts has decided to recommend against approving the nasally-administered influenza vaccine, FluMist®. The panel had concerns about safety, raising concerns about a potential risk of pneumonia after the vaccine, as well as worsening of underlying asthma symptoms. The panel wanted to review more safety and efficacy data, especially for children in the 1 to 2 year old age range. Reuters Health

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